Case 1: HIV Testing as the Gateway to Care: A 28-Year-Old HIV-Seronegative Man at Risk of HIV Exposure (Continued)

The patient decides that he will start PrEP once he completes his nPEP regimen. To expedite this, the patient is referred to a social worker at the STI clinic. A previous evaluation did not indicate that the patient had any issues with access to housing, access to food, violence, or other social drivers of HIV exposure; however, he was uninsured. The STI clinic and EtE social worker focus on identifying the benefits he would qualify for that would allow him to access primary care that includes PrEP-related care and medications. Review of his financial situation reveals that the patient qualifies for the New York State Medicaid program. The patient and the social worker begin completing the Medicaid paperwork and enlist the help of a clinic navigator to assist the patient through the process.

The patient completes his nPEP and remains HIV seronegative at his week 4 test. He has not yet completed his Medicaid application. After another medical visit and no clinical evidence of acute HIV infection, the patient and practitioner decide to initiate PrEP using starter packs provided by the clinic through its immediate-start PrEP program while the patient’s insurance issues are sorted out.

One week later, the patient’s Medicaid is activated and the navigator uses the New York City PrEP site locator, similar to PrEP provider registries being developed in other jurisdictions, to identify a clinic vetted by New York City that is able to provide PrEP. The patient selects a clinic that accepts his insurance and is part of the New York City–funded network of clinics that provides PrEP and supportive services, and his patient navigator is able to orchestrate a same-week appointment for the patient to continue PrEP-related care. The navigator works with the patient and the PrEP navigator at the PrEP network site to schedule an appointment and offers to accompany the patient to his first visit. The patient declines but agrees to provide a release that will allow the navigator to transmit medical records to his PrEP practitioner. After consent is obtained, the PrEP network site is provided with copies of the patient’s HIV testing, STI testing, and treatment histories, as well as a letter documenting his recent initiation of PrEP that includes his baseline laboratory test results.

Two weeks later, the patient confirms that he is connected to care and that his new practitioner has agreed to continue prescribing PrEP and follow guidelines from New York State regarding appropriate PrEP-related care.